HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit. Number:
200H A
Building Permit Application
. !� I.;
Countjr
Planning and Development Services Pe" ml@69
Building and Code Regulation Division Commercial Residential V/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: 1120 "1 e
Property Tax lD#: -A
SitePlan Name:
Project Name:
11
New Electrical Meter -Second Electrical Meter (Affidavit required)
Lot NoA2�__
Block No.
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank —Gas Piping Shutters Windows/Doors Pond
— Electric — Plumbing — Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ eo
- !2- (09 Q �- — Utilities: —Sewer _Septic
Building Height: _
-� �n .1 -111.111- 1K
Name711. ii
ame:i fi��Wd-�o Lle)-K.-�5c'o
Address:. 131 PY &\Ji Company:
City: State.-
T-L- Address:2 d
Q\
Zip Code: "22T9 (n Fax: City: n �%' _5 V -2
X72-\ " Qfc e State:
I - Phone No. E- Zip Code: Fax:
Mail: I - - -- -T
Phone No 3L) 2- — 6 q
Fill in fee simple Title Holder on next page (if different E-MailAZUA,.Jd Aj&C0
i-I j\�J[ l, jot 0 A
from the Owner listed above) State or County License -I'V.�C 126-S,'53
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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tIICTIbN,aLIN Ll�W iNFOR'IV�ITIOIV `i„�r
177
`77
DE SIGNER/ENGa.,'•.r
INEER:
_ Not Applicable
Name: �AU� A p� � 'NC.
MORTGAGE COMPANY: _ Not Applicable
Address: t-t0PC_:t) g�� lit{
Name:
Address:
City. State:"F
City:
Zip: Phone 'l_ - 9&
Zip:
state:
Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Name:
City:
Address:
Zip: Phone:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules,bylaws
structure. Please consult with your Homeowners Association and reviewour deed for any restntctionrestrict
wh ch maprohibit pysuch
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the worky
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your !ai Ile to Rec d a Notice of Commencement may result in paying twice for
improvements to your pr erty. A Noti a of Commencement must be recorded in the public records of St.
Lucie County and posted n the jobsite efore the first inspection. If you intend to obtain financing, consult
with lend r an attorn b ore com encin work or recording our Notice of Commencement.
i'
Signature of Contractor -
STATE OF FLORIDA
COUNTY OF
Sworn to (or affi
this day of
Name of person makir
Personally Known
Type of Id-entification 1
(Signature of
applicable
and subscribed before me of
7m 20Q by
statement.
OR Produced Identification
blic- State of Florida)
Commission No. (Seal)
REVIEWS
RECEIVED
DATE
COMPLETED
Physical Presence or Online Notarization
s�;c;' AUDREY B. HUMPHREYi
MY COMMISSION # GG 300817
EXPIRES: March 6, 2023
Bonded Thru Notary Public Urderuriters
FRONT I ZONING PLANS
COUNTER I REVIEW I S REVIEWOR I RE E%A
r
VEGETATION
REVIEW
SEA TURTLE
REVIEW .
MANGROVE
REVIEW